This young woman didn't know her birth control pills could cause a blood clot in leg that would kill her. Here, Anna's mother recounts the devastating story.

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Anna Frutiger had the world by the tail in the spring of 2010. The 23-year-old Michigan native was busy working toward her longtime dream of becoming a dentist. Athletic, pretty, and smart, Frutiger had just finished her first year at dental school in Pittsburgh when the unimaginable happened. A blood clot in her lungs, called a pulmonary embolism, landed her in a hospital emergency room in mid-May. Frutiger was fighting for her life.

That day was the culmination of a health crisis four months in the making. While training for a triathlon, Frutiger began feeling pain behind her knee and calf. “Her symptoms seemed to come and go — sometimes being very painful and other times they seemed to disappear,” recalled Sara Wassenaar, DDS, Frutiger’s mother, herself a dentist in Alma, Mich. At first she believed her leg pain was muscle-related, but Frutiger told her mother it wasn’t exactly the sort of pain she experienced with other muscle pulls. She was becoming unusually short of breath as well.

Eventually, Frutiger saw an orthopedic surgeon who suspected that a blood clot called a deep vein thrombosis (DVT) was the culprit. A DVT forms in large veins, typically in the legs. It’s usually seen in much older people or those who are obese, are sedentary, or have other health problems like cancer, certain blood clotting disorders, or recent trauma or surgery.

Frutiger didn’t fit the typical picture of a person who would develop a deep vein thrombosis. But she did have an important risk factor: She was taking hormonal birth control pills.

An ultrasound/Doppler of her leg did not detect a deep vein thrombosis. At a follow-up visit three weeks later, her leg looked normal and wasn’t painful. The doctor sent her home.

Anna Frutiger’s Fight for Life

During May 2010, Frutiger traveled a lot. She flew for six hours over two consecutive weekends and had recently returned from an eight-hour bus trip with just one short stop when Wassenaar spoke with her daughter on the phone.

“She was emotional and shared with me that she was very short of breath as she was bringing groceries up to her apartment," her mother said. Frutiger chalked up her symptoms to the stress of dental school. “I will never fully forgive myself for not recognizing how serious her situation was and for not insisting she go to the emergency room,” Wassenaar said.

The next day, Frutiger asked a friend to drive her to class because she still didn’t feel well. But on her way to the car, she collapsed and blacked out. Frutiger went into cardiopulmonary arrest shortly after arriving at the ER. In a mix of shock and panic, Wassenaar and her husband, Rich Frutiger, DDS, raced to their daughter’s side. “It was a parent’s worst nightmare,” she said. Doctors discovered a foot-long blood clot in her lungs. “She suffered a bilateral saddle pulmonary embolism, which essentially cut off blood flow to the heart,” Wassenaar said. The undiagnosed DVT had broken free and traveled to her lungs.

Over the next few days, doctors kept the aspiring dentist alive in hopes of a miracle. But Frutiger was comatose and tests found no brain activity. Her parents made the agonizing decision to take her off life support.

Frutiger died on May 20, 2010.

The Link Between Deep Vein Thrombosis and Birth Control

The doctors looked for a reason why such a young, seemingly healthy, nonsmoking woman developed a deep vein thrombosis. At autopsy, no clotting disorder that would explain the huge blood clot was found. The rest of Frutiger’s family was tested for hereditary clotting problems, which all came back negative.

Wassenaar said that doctors believed the combination of oral contraceptives and being immobile because of all the travel triggered the massive clot.

So what’s the link between deep vein thrombosis and birth control? “The hormones that are in birth control pills (synthetic estrogen and progesterone in combination pills) as well as the hormones in hormone replacement therapy and the surge of hormones when a woman is pregnant lead to changes in the blood that promote thrombosis, or clotting," said Natalie Evans, MD, a vascular medicine specialist at the Cleveland Clinic in Ohio. "In most cases the baseline risk of thrombosis for young, healthy women of childbearing age is quite low, so even though birth control pills and pregnancy increase the risk of clotting, the overall risk still remains quite low.

Some newer, so-called third-generation, oral contraceptives have been found in some studies to carry a higher risk for blood clots. That makes a conversation with your doctor about your risk factors and the pros and cons of specific brands of birth control a smart idea. Frutiger was taking a third-generation pill.

Despite their grief, Frutiger’s family wanted to donate whatever organs were salvageable for transplant. A 50-year-old man received her liver, which saved his life.

Frutiger was originally prescribed birth control pills during her undergraduate years at Kenyon College in Ohio. Since her death, the health clinic there fully educates students on the risks of birth control pills and on the warning signs of a blood clot.

Wassenaar is passionate about sharing her daughter's story and raising awareness about DVTs and pulmonary embolism. “I hope this story reaches many women who will pay attention," she said. "Hopefully it will save some lives."

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